| NPI | 1174678221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-010503) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3745) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2013-08-23 |