| NPI | 1306520705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.014001) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301401573) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-09-10 |