NPI | 1881610509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011817) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 1935) |
Enumeration Date | 2006-07-14 |
Last Update Date | 2014-08-18 |