| NPI | 1588425573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05330) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 7092) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-04-25 |