| NPI | 1679725865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3872) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32732) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2016-10-06 |