| NPI | 1871966770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4571) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OH 4571) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2015-11-02 |