| NPI | 1255533139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3883) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010958) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2010-06-09 |