| NPI | 1770868945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4345) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10442) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2018-03-17 |