| NPI | 1992099055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007366) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4687012) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2019-06-06 |