| NPI | 1457424467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8330) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-009141) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2015-03-19 |