| NPI | 1174729479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1472) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-009665) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2007-09-24 |