| NPI | 1730408444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4073) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010243) |
| 111N00000X Chiropractor (Licence: IN 08002663A) | |
| 111N00000X Chiropractor (Licence: IN 81000133A) | |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2014-01-29 |