| NPI | 1417981374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4135) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3729) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2014-02-18 |