| NPI | 1871858019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2012023237) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012200) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2018-08-10 |