| NPI | 1699180026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5513-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5843) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2020-11-02 |