| NPI | 1770644908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038010820) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.010820) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-07-21 |