| NPI | 1043856438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008366) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013472) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2021-06-21 |