| NPI | 1518950567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: IL 038-006125) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2018-07-25 |