| NPI | 1689855447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3929) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO08260) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2014-10-14 |