| NPI | 1780398966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: OH DC-05222) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-05222) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2025-10-16 |