| NPI | 1427114172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2155) |
| Additional Taxonomies | 111NR0400X (Licence: WI 2155) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WI 2155) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2022-06-02 |