| NPI | 1033795604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5616-12) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: WI 5616-12) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2021-03-23 |