| NPI | 1164801353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2015015077) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013281) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2024-05-07 |