| NPI | 1639189731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008492) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3751) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-05-08 |