| NPI | 1053302372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: IL 038007445) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: WI 4861-12) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2012-04-09 |