| NPI | 1700440138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013393) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL PENDING) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2025-05-02 |