| NPI | 1710445382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013534) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010784) |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2021-10-20 |