| NPI | 1568892172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2013039643) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012503) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2013-11-18 |