| NPI | 1821119934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4313) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4935) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2008-09-08 |