| NPI | 1174695076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009241) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3716-12) |
| 111N00000X Chiropractor (Licence: OH DC.3095) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2010-08-18 |