| NPI | 1720353709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: IL 038012321) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002642A) |
| 111NR0400X (Licence: IN 08002642A) | |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2016-02-26 |