| NPI | 1407993512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4421-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556503) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-12-21 |