| NPI | 1508559683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: IL 038.013992) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013992) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2023-06-02 |