| NPI | 1548497605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 1664-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 1740) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2017-10-26 |