| NPI | 1225021512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-03359) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3359) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2023-02-16 |