| NPI | 1639352917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012630) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007022) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2014-06-28 |