NPI | 1063727733 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5422) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4652-12) |
Enumeration Date | 2010-08-18 |
Last Update Date | 2018-08-30 |