| NPI | 1962662247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3916) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-04563) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-10-20 |