| NPI | 1982790838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 16038009439) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA IA06277) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |