| NPI | 1255480729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3001) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 740) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-09 |