| NPI | 1619289261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011514) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 27-2998137) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2010-08-11 |