| NPI | 1093096323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4791-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11718) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2025-09-05 |