| NPI | 1710318142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2852) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012545) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2023-11-28 |