| NPI | 1710933668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-008760) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A06190) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2011-01-03 |