| NPI | 1356522007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002715A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038008672) |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2013-08-05 |