| NPI | 1467544262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC4619) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006-0000903) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2021-01-23 |