| NPI | 1851370530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006855) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 1801) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2021-06-09 |