| NPI | 1538103932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 3336) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3336-012) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-09-20 |