| NPI | 1336345859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-011148) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007011958) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2010-10-20 |