| NPI | 1194129460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 075616) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4458) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2014-10-15 |