| NPI | 1679791768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4375) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8662) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2016-10-18 |