| NPI | 1639736424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34540) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013373) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2022-08-24 |