| NPI | 1346753985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5406) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010615) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2020-02-18 |