NPI | 1386764835 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2005035665) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010515) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2008-07-24 |