| NPI | 1851506364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5126) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010703) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2017-02-01 |