| NPI | 1417340845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5765-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4544) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2022-06-08 |