| NPI | 1518396936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4972-12) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1436-39) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2014-09-25 |