| NPI | 1316491939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5251-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO chr.0007479) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2018-04-11 |