| NPI | 1528060977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249348) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2640) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2024-04-15 |