| NPI | 1184622102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 818) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 82000818) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2010-02-17 |