| NPI | 1093709305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4350-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 1362) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2018-03-17 |