| NPI | 1811289085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: IL 038003761) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: WA CH00034818) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2013-09-18 |