| NPI | 1619117090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-4070) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-31064) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2012-07-31 |