| NPI | 1316245574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012047) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5279) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2018-01-10 |