| NPI | 1265547145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038006978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-009548) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2016-07-20 |