| NPI | 1073753521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S04065) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011370) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2023-08-23 |