| NPI | 1457854994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2018008643) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013367) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2024-09-26 |