| NPI | 1205932449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2409-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2409-12) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2022-12-07 |