| NPI | 1316162449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038008821) |
| Additional Taxonomies | 111NR0400X (Licence: IL 038008821) |
| 111NX0800X Chiropractor, Orthopedic (Licence: IL 038008821) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-10-16 |