| NPI | 1568507341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH OHIO1564) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 0006186) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2015-04-24 |