| NPI | 1427582170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012794) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 074677) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2017-04-19 |