| NPI | 1528501905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013076) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4194) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2017-02-07 |