| 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 |