| NPI | 1740230218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011137-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010189) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2012-09-13 |