| NPI | 1447982798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5922) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013869) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2025-06-16 |