| NPI | 1689863672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2592-012) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: WI 2592-012) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2007-10-16 |