| NPI | 1609954049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 1734012) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WI 18055) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2008-06-30 |