| NPI | 1700292661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC.4486) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012632) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2017-05-03 |