| NPI | 1487164349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4664) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2995) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2018-03-17 |