| NPI | 1720271158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 869) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WV 869) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2013-10-02 |