| NPI | 1528367521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2200-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2463) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2012-05-09 |