| NPI | 1821130899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 261113) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2024-09-30 |