| NPI | 1104303221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12509) |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2023-10-05 |