| NPI | 1629144654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 407) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV WV407) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2019-08-23 |