| NPI | 1366767170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011606) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60203269) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2011-05-27 |