| NPI | 1467572628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: IL 038.010896) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3342) |
| 111N00000X Chiropractor (Licence: IL 3801096) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2018-03-17 |