| NPI | 1679548838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC 4332) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009362) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2015-09-15 |