| NPI | 1538560453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4492) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2014032192) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2020-11-16 |