| NPI | 1922216670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4020) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010389) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2013-01-31 |