| NPI | 1245237189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2614) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-009505) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-06-12 |