| NPI | 1538758818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.013653) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038.013653) |
| 111NS0005X Chiropractor, Sports Physician (Licence: IL 013653) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: IL 038013653) | |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-12 |