| NPI | 1558608497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: OH 4347) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: PA DC010705) |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2025-05-16 |