| NPI | 1497893424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4286-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007055) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2018-10-23 |