| NPI | 1033592001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010414) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012826) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2016-03-24 |