| NPI | 1437458304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011964) |
| Additional Taxonomies | 261Q00000X (Licence: IL 038011964) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2017-11-30 |