NPI | 1912915752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009507) |
Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: IL 038009507) |
111NN0400X Chiropractor, Neurology (Licence: IL 038009507) | |
111NX0800X Chiropractor, Orthopedic (Licence: IL 038009507) | |
Enumeration Date | 2006-08-04 |
Last Update Date | 2012-10-03 |