| NPI | 1093088924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012148) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038012148) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2012-02-23 |