| NPI | 1518971902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038004730) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IL 198000187) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2012-09-12 |