| NPI | 1114478872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4349) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5511) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2019-01-16 |