| NPI | 1023349321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4575-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8105) |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2021-05-11 |