| NPI | 1003561242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.014002) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 112327) |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2024-01-10 |