| NPI | 1306965876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009352) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: IL 038-009352) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-01-22 |