| NPI | 1134172166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038010132) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002163A) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2008-02-11 |