| NPI | 1821038753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006888) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5237) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2011-09-09 |