| NPI | 1902987860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038004976) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3769) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |