| NPI | 1992884498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: IL 038-005127) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: IL 038-005127) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-10-13 |