| NPI | 1962939983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OH 4718) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4718) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2021-07-21 |