| NPI | 1033436738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011897) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2425) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2011-03-11 |