| NPI | 1306482427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.014021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34510) |
| Enumeration Date | 2019-11-24 |
| Last Update Date | 2026-05-05 |