| NPI | 1154863215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 087568) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013047) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2022-07-21 |