| NPI | 1992867725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-006379) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: IL 038-006379) |
| 111NR0400X Chiropractor Rehabilitation (Licence: IL 038-006379) | |
| 111NS0005X Chiropractor Sports Physician (Licence: IL 038-006379) | |
| 111NX0100X Chiropractor Occupational Health (Licence: IL 038-006379) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2009-03-31 |