| NPI | 1386040681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: IL 038.012992) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038.012992) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2016-12-31 |