| NPI | 1821260894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.011649) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6214) |
| Enumeration Date | 2008-03-29 |
| Last Update Date | 2020-08-31 |