| NPI | 1982824033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4448-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3960) |
| 171100000X Acupuncturist (Licence: MN 554) | |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2009-05-06 |