| NPI | 1205400108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038014138) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2021017566) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2024-05-24 |