| NPI | 1225107709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1904) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OH 117) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2022-07-21 |