| NPI | 1477597268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009376) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3455) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-03-29 |