| NPI | 1306171954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8188) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011396) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2018-01-24 |