| NPI | 1922177765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038009492) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: IL 038009492) |
| 111NR0400X (Licence: IL 038009492) | |
| 111NN0400X Chiropractor, Neurology (Licence: IL 038009492) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2012-10-03 |