| NPI | 1063473940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 2006) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002022A) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2012-04-16 |