| NPI | 1558028704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05166) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010659) |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2022-04-28 |