| NPI | 1285667147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4990) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 857) |
| 111N00000X Chiropractor (Licence: OH 3780) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2009-03-02 |