| NPI | 1790979508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012471) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO06423) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2015-07-21 |