| NPI | 1700925815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 2393) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: OH 6393) |
| 111NN1001X Chiropractor Nutrition (Licence: OH 6393) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: OH 6393) | |
| 111NS0005X Chiropractor Sports Physician (Licence: OH 6393) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2016-08-02 |