| NPI | 1811092091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4102) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4663) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2011-02-25 |