| NPI | 1184060295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011970) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: IL 038.011970) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2021-01-05 |