| NPI | 1366760308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 38011689) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011689) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2018-06-21 |