| NPI | 1205160991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5273) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4481-012) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2009-09-29 |