| NPI | 1104379544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013004) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038.013004) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2016-08-02 |