| NPI | 1255601258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012525) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2016-09-23 |