| NPI | 1417532540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 6094) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6790) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2024-08-08 |