| NPI | 1508195348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 31392) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011567) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2019-02-11 |