| NPI | 1699801175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.013396) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-08-22 |