| NPI | 1619035300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1714) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001286) |
| 111N00000X Chiropractor (Licence: KY 4112) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-05-16 |