| NPI | 1750701124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OR 5122) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4430) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2024-02-05 |