| NPI | 1134119092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1731) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: OH 1731) |
| 111NR0200X Chiropractor, Radiology (Licence: OH 1731) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: OH 1731) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2014-12-31 |