| NPI | 1407862329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4299-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010229) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-10-02 |