| NPI | 1548772247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5655-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1319) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2021-05-04 |