| NPI | 1629306071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01069) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011976) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2011-07-05 |