| NPI | 1831108216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 4679) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010618) |
| 111N00000X Chiropractor (Licence: SC 1374) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-12-03 |