| NPI | 1699054437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4212) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10312) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2015-07-09 |