| NPI | 1952734535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012505) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009173) |
| Enumeration Date | 2013-08-18 |
| Last Update Date | 2015-04-16 |