| NPI | 1942458401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4437-012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4437-12) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2021-08-20 |