| NPI | 1104850445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006653) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A05584) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-05-13 |