| NPI | 1568670990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3598) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5125) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-07-21 |