| NPI | 1487042818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012858) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2014040733) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2020-03-03 |