| NPI | 1144812652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3514) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-05041) |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2024-03-05 |