| NPI | 1699631192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 6367-012) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MO 2025053729) |
| Enumeration Date | 2025-12-29 |
| Last Update Date | 2026-07-10 |