| NPI | 1164462099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4373) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3913012) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-08 |