| NPI | 1679911804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OH 4656) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4321) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2017-03-27 |