| NPI | 1083744528 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 2002) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5192) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |