| NPI | 1508930900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 05075) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038005319) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2010-02-11 |