| NPI | 1942293345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 124592) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2547-012) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2024-11-18 |