| NPI | 1154893717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003084A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013292) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2019-02-13 |