NPI | 1801463252 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013723) |
Additional Taxonomies | 111NR0400X (Licence: IL 038.013723) |
Enumeration Date | 2021-06-04 |
Last Update Date | 2023-01-26 |