| NPI | 1568690972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4508-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2009014144) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2012-09-04 |