| NPI | 1386181469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013163) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00741700) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2023-05-13 |