| NPI | 1821145251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038009230) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3590) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2012-09-06 |