| NPI | 1487024295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: OH 4480) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: MO 2014039521) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2015-10-06 |