| NPI | 1356480222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: IL 038-006768) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: IA A05679) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2011-10-13 |