| NPI | 1457423774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC26679) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010386) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-08-09 |