| NPI | 1245347905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3735-012) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2019-04-23 |