| NPI | 1346400587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012462) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160.004156) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2016-08-12 |