| NPI | 1700982659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI WI3392012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI WI3392-012) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-01-06 |