| NPI | 1376263459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013891) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 038013891) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2022-08-31 |