| NPI | 1881087088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4611) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2793) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2016-06-02 |