| NPI | 1760557169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OH 1232) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 1232) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-10-24 |