| NPI | 1891791638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9084) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038008990) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2025-05-02 |