| NPI | 1326048604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6284) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4023) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-12-27 |