| NPI | 1316971369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038007934) |
| Additional Taxonomies | 293D00000X Physiological Laboratory (Licence: IL 038-007934) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-10-24 |