| NPI | 1982908141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8233971-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011822) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2012-11-19 |