| NPI | 1841316973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009597) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038-009597) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2016-07-13 |