| NPI | 1902883416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1730) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 762) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2013-06-17 |