| NPI | 1538254123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.006626) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038006626) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-01-12 |