| NPI | 1063629509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4965-12) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NH 761-0406) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-10-18 |