| NPI | 1679951693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013363) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2015013421) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2019-10-16 |