| NPI | 1720468952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012808) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IL 198001256) |
| 225000000X Orthotic Fitter (Licence: IL C53612) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL S62117) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-05-03 |