| NPI | 1326472671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4956-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007676) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2021-04-15 |