| NPI | 1821272535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 38010089) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041432301) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2015-10-28 |