| NPI | 1003992165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 583) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 1925) |
| 111N00000X Chiropractor (Licence: KY 4193) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2015-10-14 |