| NPI | 1639149081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009890) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008629) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2012-05-07 |