| NPI | 1790834034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 264) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: WV 264) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-09 |