| NPI | 1174894281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 15955) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2022-07-21 |