| NPI | 1861961690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013285) |
| Enumeration Date | 2018-11-22 |
| Last Update Date | 2023-11-01 |