| NPI | 1942296538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2000165673) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-008506) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2007-10-31 |