| NPI | 1144997412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5678-12) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: WI 5678-12) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2023-01-26 |