| NPI | 1982743241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor, Occupational Health (Licence: MN 4367) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MN 4367) |
| 111NX0800X Chiropractor, Orthopedic (Licence: MN 4367) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2015-07-30 |