| NPI | 1750390076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3741) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038009946) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-04-26 |