| NPI | 1861138646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05418) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5759-12) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2025-02-12 |