| NPI | 1083207914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013679) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2021003494) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |