| NPI | 1932777364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04961) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: OH DC-04961) |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2022-12-19 |