| NPI | 1821751645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC05385) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13760) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2024-10-01 |