| NPI | 1154610293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 04851) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 8947434-1202) |
| 111N00000X Chiropractor (Licence: AZ 8195) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2018-12-17 |