| NPI | 1023294170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4624) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5031) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2016-11-03 |