| NPI | 1457616476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 0122111) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012209) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2013-04-30 |