| NPI | 1770041022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038013388) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH dc-04876) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2020-03-21 |