| NPI | 1346281292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009927) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 25547) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2016-03-03 |