| NPI | 1477559797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC3976) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8247) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2010-11-24 |