| NPI | 1215057344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08001736A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-008216) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2022-01-31 |