| NPI | 1124246467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4824) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3205) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2022-09-07 |