| NPI | 1699864108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4541) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4257) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-14 |