| NPI | 1174951156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4928-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5817) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2014-05-16 |