| NPI | 1699782144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038006933) |
| 111NS0005X Chiropractor Sports Physician (Licence: IL 038006933) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2024-09-17 |