| NPI | 1093086001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249463) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5322) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2019-11-01 |