| NPI | 1073556486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.010421) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010421) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-09-18 |