| NPI | 1225126931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 437) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3858) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2013-04-03 |