| NPI | 1518375682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4980) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2650) |
| 111N00000X Chiropractor (Licence: MO 2013007171) | |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2014-08-01 |