| NPI | 1982921367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011669) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4661012) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2019-09-26 |