| NPI | 1922122142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038004515) |
| Additional Taxonomies | 111NR0400X (Licence: IL 038004515) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-04-19 |