| NPI | 1548696701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04390) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11847) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2020-09-18 |