| NPI | 1174931141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012654) |
| Additional Taxonomies | 111NR0400X (Licence: IL 038.012654) |
| 111NS0005X Chiropractor, Sports Physician (Licence: IL 038.012654) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: IL 038.012654) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |