| NPI | 1265674741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4475-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4475) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2023-09-25 |