| NPI | 1720275654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY 011563) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OH 3910) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2021-10-07 |