| NPI | 1780739284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-010281) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010281) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2019-02-08 |