| NPI | 1083925150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5310) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3542) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2014-08-15 |