| NPI | 1538300637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4434-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN DC-4392) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2009-03-19 |