| NPI | 1063991602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2016006140) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013427) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2020-07-16 |