| NPI | 1679698138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3949) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4261-012) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-03-19 |