| NPI | 1073649752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011044) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009292) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-02-24 |