| NPI | 1295815256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009719) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010623) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-07-19 |