| NPI | 1396851457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8128) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038009830) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-12-30 |