| NPI | 1154647709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4598-012) |
| 111N00000X Chiropractor (Licence: IL 038.011601) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2013-01-17 |