| NPI | 1811403249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04949) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013174) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2025-09-11 |