| NPI | 1063685246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038-005498) |
| Additional Taxonomies | 111NR0400X (Licence: IL 038005498) |
| 111NR0400X (Licence: IL 038-005498) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: IL 038-005498) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2016-12-06 |