| NPI | 1497060099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5419) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011903) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2016-12-30 |