| NPI | 1083972871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012359) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32297) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2016-02-11 |