| NPI | 1689813024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32997) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011210) |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2019-06-11 |