| NPI | 1649376799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006834) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IL 198-000151) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2015-07-18 |