| NPI | 1487638482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2412-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2412012) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2008-12-02 |