| NPI | 1417929621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: WI 1707) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WI 1707) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2010-10-25 |