| NPI | 1245461706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2010002033) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011492) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2025-01-20 |