| NPI | 1699957563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-011158) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3708012) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2015-09-11 |