| NPI | 1679879050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4838-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008777) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2012-07-06 |