| NPI | 1922473503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003479A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA. 10141) |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2025-07-22 |