| NPI | 1568514628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: OH 1974) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: OH 2974) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2017-05-01 |