| NPI | 1043559255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012898) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013003229) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2016-05-12 |