| NPI | 1467782409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2791) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4179) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2021-01-18 |