| NPI | 1790979045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-03933) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO08201) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2023-01-04 |