| NPI | 1245358258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4516) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 717) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WV 717) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2021-11-19 |