| NPI | 1346348794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-00872) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 0872) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-01-16 |