| NPI | 1538324983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5063) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011204) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2020-12-17 |