| NPI | 1649336736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3801) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010845) |
| Enumeration Date | 2006-12-31 |
| Last Update Date | 2015-09-24 |