| NPI | 1417930686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: IL 165000214) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: IL 038006898) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2020-03-26 |