| NPI | 1053828863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04761) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: OH DC-04761) |
| 111NN1001X Chiropractor, Nutrition (Licence: OH DC-04761) | |
| 111N00000X Chiropractor (Licence: NJ 38MC00754600) | |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2018-07-31 |