| NPI | 1720460991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012523) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007637) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |