| NPI | 1881786424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-011-840) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 1588) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2019-03-20 |