| NPI | 1588672687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038007401) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IL 198.000230) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2008-04-22 |