| NPI | 1497463855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013669) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008596) |
| 111N00000X Chiropractor (Licence: MO 2021003453) | |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2025-05-21 |