| NPI | 1932215498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009874) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2006003308) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-03-25 |