| NPI | 1912213216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA CH3293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011685) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-09-10 |