| NPI | 1063726560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007193) |
| 111N00000X Chiropractor (Licence: PA DC010240) | |
| 111N00000X Chiropractor (Licence: MI 2301009519) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2015-08-31 |