| NPI | 1992479091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05384) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013749) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2024-10-10 |