| NPI | 1356372742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4497-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1080) |
| 111N00000X Chiropractor (Licence: IA 007056) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2009-04-18 |