NPI | 1275933608 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OH DC4453) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC4453) |
171100000X Acupuncturist (Licence: OH 65.000287) | |
111N00000X Chiropractor (Licence: OH ACUP153) | |
Enumeration Date | 2014-09-04 |
Last Update Date | 2021-08-03 |