| NPI | 1821151499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009785) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IL 198.000636) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2011-09-02 |