| NPI | 1376731109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009569) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 038-009569) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2018-07-24 |