| NPI | 1558375352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC1372) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: OH 1372) |
| 111N00000X Chiropractor (Licence: WV 479) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-10-05 |