| NPI | 1770800856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2010040603) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2409) |
| 111N00000X Chiropractor (Licence: IL 038011654) | |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2024-01-03 |