| NPI | 1023134822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 443152) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30440) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2021-07-21 |