| NPI | 1780893628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: WI 4717-12) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: VA 0104001349) |
| 111NN0400X Chiropractor, Neurology (Licence: IL 038.012332) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2024-06-05 |