| NPI | 1053376277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4214-012) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 742-039) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2020-06-11 |