| NPI | 1447915723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3554) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013750) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2022-08-22 |