| NPI | 1568929016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC04883) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011452) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2022-10-05 |