| NPI | 1851522023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3422) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011479) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2016-08-05 |