| NPI | 1710127394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5164) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4474-12) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2021-04-12 |