| NPI | 1073905345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 121213) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012768) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2024-02-26 |