| NPI | 1043676596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5430-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002850A) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2019-02-14 |