| NPI | 1346211992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2002004526) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL IL038-009736) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-06-25 |