| NPI | 1811095821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8355) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010679) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-08-28 |