| NPI | 1528137601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-010002) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 5005) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-10-25 |