| NPI | 1205354503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor Neurology (Licence: IL 038013140) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: IL 038013140) |
| 111NP0017X Chiropractor Pediatric Chiropractor (Licence: IL 038013140) | |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2019-04-12 |