| NPI | 1336223197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038007330) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3880) |
| 111N00000X Chiropractor (Licence: MA 1856) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2010-07-12 |