| NPI | 1891898359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2004022080) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010206) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2012-07-19 |