| NPI | 1063002376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 6002) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003218A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2025-11-03 |