| NPI | 1649616004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S04101) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012422) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2023-05-17 |