| NPI | 1043665326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04986) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DC 12221) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2020-09-14 |