| NPI | 1710960984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3803) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4768) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-01-29 |