| NPI | 1609835289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 1488) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 6062) |
| 111N00000X Chiropractor (Licence: IL 038007895) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2023-11-02 |