| NPI | 1710024054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-01029) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 0004070-012) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-09 |