| NPI | 1700405925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013112) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301011021) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2024-04-16 |