| NPI | 1760727937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: WI 1883) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: WI 1883) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: MI 2301005616) | |
| 111NS0005X Chiropractor Sports Physician (Licence: WI 1883) | |
| 111NS0005X Chiropractor Sports Physician (Licence: MI 2301005616) | |
| 111NX0800X Chiropractor Orthopedic (Licence: MI 2301005616) | |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2012-11-29 |