| NPI | 1376791467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 383029) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001082) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |