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 |