| NPI | 1487167151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5332) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013123) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2021-02-04 |