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