| NPI | 1417901422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: WI 2800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2800) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WI 2800) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2026-01-14 |