| NPI | 1225101876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011402) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2002013828) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2022-12-28 |