| NPI | 1245395565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3971) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3831) |
| 111N00000X Chiropractor (Licence: IL 038011253) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2010-06-16 |