| NPI | 1093039059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4269) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1815) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2017-03-15 |