| NPI | 1982632519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 004287) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038004479) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-08 |