| NPI | 1215183793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 2094) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: KY 4237) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2008-08-15 |