| NPI | 1588757447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 38-5828) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 385828) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2010-03-31 |