| NPI | 1770826638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172P00000X Naprapath (Licence: IL 181.000369) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.001899) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2013-03-28 |