| NPI | 1366740128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011878) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4200) |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2014-10-22 |