| NPI | 1881885879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4997) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4398-012) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2023-01-06 |