| NPI | 1568550507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: OH 3386) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: KY 4811) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-09 |