| NPI | 1871197459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3501) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013632) |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2024-12-26 |