| NPI | 1255377057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249286) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 760) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2019-12-16 |