| NPI | 1497109920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 04024) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 12009) |
| 111N00000X Chiropractor (Licence: OH 4613) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2021-06-10 |