| NPI | 1417102856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4501-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007149) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2018-03-17 |