| NPI | 1720029689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1727) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI 741) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-07-01 |