| NPI | 1285196162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5639) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 1102) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-04-12 |