| NPI | 1760800221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 087903) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012600) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-09-02 |