| NPI | 1154546240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3522) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010666) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-08-26 |