| NPI | 1679988018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 038012631) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012631) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2018-09-14 |