| NPI | 1669588042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08001791A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2663) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |