| NPI | 1629659677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5651-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 565112) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2023-08-09 |