| NPI | 1861464638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WI 5347-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010367) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2024-06-04 |