| NPI | 1770528051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1539) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 005741) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2013-08-14 |