| NPI | 1972657344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: IL 038010873) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: IL 038010873) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-10-31 |