| NPI | 1477994556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5784) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012368) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2017-07-18 |