| NPI | 1497782494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS C3463) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038009788) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2007-08-31 |