| NPI | 1659497790 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038009568) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: IL 038009568) |
| 111NR0400X (Licence: IL 038009568) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: IL 038009568) | |
| 111NT0100X Chiropractor, Thermography (Licence: IL 038009568) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: IL 038009568) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |