| NPI | 1790863264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 3049) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA AO5755) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-07-03 |