| NPI | 1669446142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 794) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3299) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-06-17 |