| NPI | 1366591059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| 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 Chiropractor Rehabilitation (Licence: IL 038009791) | |
| 111NX0800X Chiropractor Orthopedic (Licence: IL 038009791) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2021-11-16 |