| NPI | 1851443329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038010408) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011309) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2022-06-17 |