| NPI | 1396352407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: IL 038013603) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038013603) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-11-24 |