| NPI | 1598740680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 405) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3797) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2018-11-16 |