| NPI | 1801991922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 1326) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: WI 1326) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2010-07-28 |