| NPI | 1811139611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 12448) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011086) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2024-09-09 |