| NPI | 1780654681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-004778) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: IL 038-004778) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2007-07-08 |