| NPI | 1326378753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1274) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 127) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2021-02-23 |