| NPI | 1083106215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 05086) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 12431) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2022-01-03 |