| NPI | 1245217827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 863) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 2015L) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2015-12-09 |