| NPI | 1760240485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: OH DC-05107) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.022085) |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |