| NPI | 1851315204 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC1373) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 480) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-08-14 |