| NPI | 1306866306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 3519-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3519-012) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-04-25 |