| NPI | 1396937272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OH 4013) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3752) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2023-03-23 |