| NPI | 1871952473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013481) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL in process) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2020-03-04 |