| NPI | 1891764098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009097) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: IL 238000485) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2022-03-30 |