| NPI | 1558493247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 2177) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2340) |
| 111N00000X Chiropractor (Licence: NC 4272) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2015-06-05 |