| NPI | 1003841701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038007884) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 4864) |
| 171100000X Acupuncturist (Licence: IL certificate) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-01-29 |