| NPI | 1700138013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04985) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010726) |
| 111N00000X Chiropractor (Licence: VA 0104557356) | |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2022-06-01 |