| NPI | 1831492917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7868356-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007355) |
| 111N00000X Chiropractor (Licence: IL 038011806) | |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2014-01-22 |