| NPI | 1508028754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KS 0106163) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011199) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-01-24 |