| NPI | 1992700892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.003376) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038003376) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2009-08-28 |