| NPI | 1124323993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10171) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2015-04-06 |