| NPI | 1194986984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5273) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011197) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2011-06-01 |