| NPI | 1619174745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006431) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00002423) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2012-04-30 |