| NPI | 1942405907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4006) |
| Additional Taxonomies | 111NR0400X (Licence: MD 03523) |
| 111N00000X Chiropractor (Licence: MD 03523) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2018-04-18 |