| NPI | 1689667842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301101777) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038008150) |
| 111N00000X Chiropractor (Licence: MI 2301010255) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-137314) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2021-03-30 |