| NPI | 1003804154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038005630) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 5465) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2007-07-08 |