| NPI | 1588663033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 14318) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3416) |
| 111N00000X Chiropractor (Licence: KY 4768) | |
| 111N00000X Chiropractor (Licence: WV 971) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-12-28 |