| NPI | 1508894205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125081933) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 38009741) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2025-02-12 |