| NPI | 1053315663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-005639) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 005331) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2007-12-17 |