| NPI | 1841881307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 6143-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6798) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2024-04-09 |