| NPI | 1285753921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2021013227) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012969) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-05-23 |