| NPI | 1043286081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012345) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 008133) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2018-06-11 |