| NPI | 1649413410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2009002883) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011355) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-04-09 |