| NPI | 1578078838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013405) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2017014934) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2020-02-04 |