| NPI | 1316026172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006596) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5514) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2014-03-27 |