| NPI | 1215064597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: WI 1512) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 1512) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2011-12-09 |