| NPI | 1881795870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-008602) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038008602) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2009-03-31 |