| NPI | 1558445346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3271) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ZZ no issued license) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2014-06-26 |