| NPI | 1295080232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4289) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012188) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2013-02-27 |