| NPI | 1437200714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 3859-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4229) |
| 111N00000X Chiropractor (Licence: IL 38010724) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2011-02-07 |