| NPI | 1235429101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5177-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-011906) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2016-10-03 |