| NPI | 1306380118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5230) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6835) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2023-09-15 |