| NPI | 1003522038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 6048-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 7059) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-01-24 |