| NPI | 1205133030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC.4408) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008627) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2014-09-30 |