| NPI | 1558425959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 2548) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: OH C53991) |
| 111N00000X Chiropractor (Licence: OH DC2548) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-11-10 |