| NPI | 1588112403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013172) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007498) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2024-07-26 |