| NPI | 1225556657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013704) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1273) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2022-07-21 |