| NPI | 1346385754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5457-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1692) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2022-01-30 |