| NPI | 1477942969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5684) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4487) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2024-03-04 |