| NPI | 1417959255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 0380005434) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-005434) |
| 111N00000X Chiropractor (Licence: IL 038-0005434) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2022-09-26 |