| NPI | 1003994567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: IL 038-004664) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038-004664) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |