| NPI | 1790855740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-010385) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC27547) |
| 111N00000X Chiropractor (Licence: AZ 7549) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2008-04-03 |