| NPI | 1972534386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3731) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 006994) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-09-22 |