| NPI | 1184254757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05070) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 265604) |
| 111N00000X Chiropractor (Licence: SC 4521) | |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2022-07-12 |