| NPI | 1558691063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011594) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010002) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2013-06-12 |