| NPI | 1245376359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04859) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038005808) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2022-11-18 |