| NPI | 1598852147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WI 1776-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 1776-12) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2017-04-04 |