| NPI | 1043429178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: WV 554) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: WV 554) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WV 554) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-03-25 |