| NPI | 1285872192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010138) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011310) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2019-06-24 |