| NPI | 1811025992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011973) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3379) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2015-07-23 |