| NPI | 1376716654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011236) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06529) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2024-02-09 |