| NPI | 1861553448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 2488) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038003638) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-10-12 |