| NPI | 1922448463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 072609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4923-12) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2015-03-18 |