| NPI | 1043756562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003327A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013058) |
| Enumeration Date | 2017-01-08 |
| Last Update Date | 2022-09-20 |