| NPI | 1790376259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3666) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013674) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2025-10-02 |