| NPI | 1972648525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1738) |
| Additional Taxonomies | 111NR0400X (Licence: OH 1738) |
| 171100000X Acupuncturist (Licence: OH 10) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-07-21 |