| NPI | 1457599029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: IL 038.011320) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: IN 08002436A) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2013-06-03 |