| NPI | 1669035606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 100448) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5450-12) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2021-02-24 |