| NPI | 1912045519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006271) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301005700) |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2007-07-09 |