| NPI | 1780785733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 510) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WV 510) |
| 204R00000X Electrodiagnostic Medicine (Licence: WV 510) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-09-09 |