| NPI | 1669464608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 972) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 4234) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2010-05-17 |