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