| NPI | 1760881320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4633) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010984) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2016-07-20 |