| NPI | 1205137627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012876) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227011976) |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2015-10-30 |