| NPI | 1124186549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4030) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4241) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-02-03 |