| NPI | 1477855062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012662) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2010038840) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2015-01-05 |