| NPI | 1013435296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04755) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH 2000017615) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2020-02-13 |