| NPI | 1912915752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-009507) |
| Additional Taxonomies | 111NR0400X (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 |