| NPI | 1609904440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 4784) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-004282) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2010-10-21 |