| NPI | 1912198714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5087) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010948) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2016-04-21 |