| NPI | 1568572477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2603 012) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: WI 2603 012) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WI 2603 012) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-07-14 |