| NPI | 1548247844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 13963) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 736) |
| 111N00000X Chiropractor (Licence: OH 3031) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-04-29 |