| NPI | 1669612024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 723) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011356) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2012-06-21 |