NPI | 1265491096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038005059) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 05060) |
Enumeration Date | 2006-03-21 |
Last Update Date | 2014-03-19 |