| NPI | 1952324691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038005567) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-05-10 |