| NPI | 1598068314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 4677) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011805) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2024-07-02 |