| NPI | 1083903918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6626) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011683) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2019-06-03 |