| NPI | 1730675026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5371-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5731-12) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2018-07-18 |