| NPI | 1720596968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X013037) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2019-06-03 |