| NPI | 1730345364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249497) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 1092) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-08-23 |