| NPI | 1558494781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 06793) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010487) |
| 111NS0005X Chiropractor, Sports Physician (Licence: IL 038-010487) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: IA 06793) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-10-08 |