| NPI | 1801086004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: IL 038.011791) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 9505TX) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2010-11-12 |