| NPI | 1851579825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5031-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5084) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2014-11-17 |