| NPI | 1043695224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013044) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009530) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2024-04-23 |