| NPI | 1679686026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 005117) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-003850) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2009-09-28 |