| NPI | 1841368909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4399) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2610) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-03-03 |