| NPI | 1386741049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2006029898) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010598) |
| 111N00000X Chiropractor (Licence: MI 2301009149) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-07-08 |