| NPI | 1679634695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: OH 762) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: WV 645) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |