| 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 |