| NPI | 1841639937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8636) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5233) |
| 111N00000X Chiropractor (Licence: IL 038012353) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2018-03-17 |