| NPI | 1538223409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4279) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6711) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-10-15 |