| NPI | 1750343877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 747) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3742) |
| 111N00000X Chiropractor (Licence: IL 038008694) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2019-05-28 |