| NPI | 1023191897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4537) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2331) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-04-27 |