| NPI | 1306373212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003095A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4719) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2020-01-12 |