| NPI | 1235377896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 928) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3967) |
| 111N00000X Chiropractor (Licence: VA 0104556672) | |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2019-04-11 |