| NPI | 1780799239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 1455) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WI 1455) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2008-09-08 |