| NPI | 1790031722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4905) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5499) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2023-05-22 |