| NPI | 1104092097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2201) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009815-1) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2008-05-01 |