| NPI | 1013756659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038014110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2024006882) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-06-12 |