| NPI | 1609296201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012554) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1598) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2016-01-05 |