| NPI | 1093801946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC1975) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010106) |
| 111N00000X Chiropractor (Licence: OH DC4674) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2019-07-08 |