| NPI | 1194995191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2008001512) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011096) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2023-10-02 |