| NPI | 1669659579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-004080) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1061) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2008-01-23 |