| NPI | 1366477341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 3623-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301007993) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-10-07 |