| NPI | 1619913951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-007867) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008725-1) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2020-11-27 |