| NPI | 1891702528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1431) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 20303) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2022-05-20 |