| NPI | 1285617225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3125) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8327) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2013-12-23 |