| NPI | 1013246214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MO 2011001253) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: IL 038.011843) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2011-01-18 |