| NPI | 1992101844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012693) |
| Additional Taxonomies | 111NR0400X (Licence: IL 038.012693) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2016-01-11 |