| NPI | 1053413864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010700) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2008-08-15 |