| NPI | 1891908356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 303) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3498) |
| 172M00000X Mechanotherapist (Licence: OH 3450) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2008-05-12 |