| NPI | 1154594026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 5202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06600) |
| 111N00000X Chiropractor (Licence: IL 038009836) | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2021-07-22 |