| NPI | 1487981775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4174) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3999) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2011-07-25 |