| NPI | 1962718197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4175) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4107) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2011-05-24 |