| NPI | 1215004924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038009621) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-009621) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2011-03-29 |