| NPI | 1578517462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1306) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OH 1306) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2022-07-05 |