| NPI | 1720416936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012516) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013036788) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2015-04-07 |