| NPI | 1396025946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4819) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4217) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2024-07-15 |