| NPI | 1104860139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3352) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9572) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2014-11-21 |