| NPI | 1760687024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10719) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.010831) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2010-07-22 |