| NPI | 1891109096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 072778) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012612) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2015-02-03 |