| NPI | 1013082734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2956) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4439) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2010-07-28 |