| NPI | 1366591059 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038009791) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: IL 038009791) |
| 111NI0900X Chiropractor, Internist (Licence: IL 038009791) | |
| 111NR0400X (Licence: IL 038009791) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: IL 038009791) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2021-11-16 |