| NPI | 1194718932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: IL 038006192) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038006192) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2010-06-07 |