| NPI | 1235296138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085001660) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038007742) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2008-09-15 |