| NPI | 1538499827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4549-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03608) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2024-02-08 |