| NPI | 1538727920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01727) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC4612) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2019-05-31 |