| NPI | 1245549658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5390) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4635-012) |
| Enumeration Date | 2010-10-02 |
| Last Update Date | 2016-09-19 |