| NPI | 1821524232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1381) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4575) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2019-06-13 |