| NPI | 1003101593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12363) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4738-012) |
| 111N00000X Chiropractor (Licence: IL 038011967) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2013-06-14 |