| NPI | 1659495083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2007022344) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 38009071) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2009-06-05 |