| NPI | 1790009827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011617) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2021-09-08 |