| NPI | 1083883755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 3459) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5111) |
| 111N00000X Chiropractor (Licence: IL 0381636348) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2019-11-06 |