| NPI | 1184720229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5921) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR0006933) |
| 111N00000X Chiropractor (Licence: IL 038-007339) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2021-01-12 |