| NPI | 1972453827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7417) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MN 7417) |
| Enumeration Date | 2026-01-30 |
| Last Update Date | 2026-01-30 |