| NPI | 1427338334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4770012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011984) |
| 111N00000X Chiropractor (Licence: IA 007563) | |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2013-09-13 |