| NPI | 1871051706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: IL 038014201) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 12721) |
| 111N00000X Chiropractor (Licence: NY 013235) | |
| 111N00000X Chiropractor (Licence: NJ 38MC00763400) | |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2024-10-14 |