| NPI | 1154780674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5292) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007380) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2018-04-19 |