| NPI | 1649375130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: CO 2228) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: MI 4625) |
| 111NR0200X Chiropractor, Radiology (Licence: IL 038.003452) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2009-11-30 |