| NPI | 1528164910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2236) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2963) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2009-11-18 |