| NPI | 1164946208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013197) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33971) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2024-02-01 |