| NPI | 1508804675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 008883) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038008702) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2025-07-23 |