| NPI | 1366815789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4559) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012707) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2015-11-06 |