| NPI | 1699021519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012217) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2010033548) |
| Enumeration Date | 2012-07-29 |
| Last Update Date | 2012-07-29 |