| NPI | 1952483430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209028355) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010483) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-02-05 |