| NPI | 1053453191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8328842-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4683) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-09-29 |