| NPI | 1003002098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: OH 3808) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10654) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2019-11-04 |