| NPI | 1700902533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-005079) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: IL 038-005079) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: IL 038-005079) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2013-06-10 |