| NPI | 1215038161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002888A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010702) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-07-12 |