| NPI | 1801527809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05186) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH APP-000605868) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2023-04-03 |