| NPI | 1619267846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011758) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011758) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2025-03-18 |