| NPI | 1407961790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009573) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038009722) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2021-07-30 |