| NPI | 1699076299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 468012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007354) |
| 111N00000X Chiropractor (Licence: IL 038.011803) | |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2017-01-29 |