| NPI | 1225162936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 3619) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3555) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |