| NPI | 1265074306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5531-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013448) |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2020-07-27 |