| NPI | 1770690653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4003-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002080A) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2021-12-29 |