| NPI | 1932128857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006416) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.006416) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-10-14 |