| NPI | 1649211855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6262) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010534) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2010-07-12 |