| NPI | 1164523502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038005562) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 1123787) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2010-05-24 |