| NPI | 1790895613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038004079) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IL 198000199) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-09-12 |