| NPI | 1760606735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009595) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038-009595) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |