| NPI | 1578225496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05180) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 104158) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2026-05-12 |