| NPI | 1619939659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1913) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 005207) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |