| NPI | 1285886762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011182) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60062374) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2012-07-09 |