| NPI | 1891736328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MD S03662) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010179) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2011-08-08 |