| NPI | 1366486177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC4233) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10716) |
| 111N00000X Chiropractor (Licence: IL 038-010443) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-06-06 |