| NPI | 1598270159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 04762) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 12339) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2017-12-05 |