| NPI | 1750622403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OH 4372) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TN 2619) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2013-03-05 |