| NPI | 1487647723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5773-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3800) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2024-01-29 |