| NPI | 1386972545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5215) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4585) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2016-09-08 |