| NPI | 1588683858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.010908) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2490) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-11-19 |