| NPI | 1851419048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 2080-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2080-012) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2019-03-18 |