| NPI | 1063429397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2006002533) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010389) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-09-11 |