| NPI | 1245350701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2007038129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010101) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-01-07 |