| NPI | 1811096878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 11366963-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.010814) |
| 111N00000X Chiropractor (Licence: MO 1347050) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-11-29 |