| NPI | 1083616999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 3795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08000990) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2009-03-13 |