| NPI | 1841249455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038010334) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6972) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2016-02-09 |