| NPI | 1699988782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05195) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12171) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2022-11-10 |