| NPI | 1629417605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012477) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: IL 038012477) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: IL 038012477) | |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2013-06-23 |