| NPI | 1922656107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013559) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013559) |
| 111N00000X Chiropractor (Licence: SC 4476) | |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2020-06-09 |