| NPI | 1033570098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5524) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 0000002877) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2018-07-25 |