| NPI | 1316120454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3877) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3754) |
| 111N00000X Chiropractor (Licence: IN 08002378A) | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2008-04-14 |