| NPI | 1366404568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038007434) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: IL 164003999) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2008-05-29 |