| NPI | 1184926156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007585) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DC CH030080) |
| 111N00000X Chiropractor (Licence: IL 038-011904) | |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2018-06-12 |