| NPI | 1306553714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 04909) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: OH 04909) |
| 111NP0017X Chiropractor Pediatric Chiropractor (Licence: OH 04909) | |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2024-10-11 |